title: Pathologic fracture does not influence prognosis in stage IIB osteosarcoma: a case-control study.
abstract: OBJECTIVE
  This study tested the implication of pathologic fractures on the prognosis in stage IIb osteosarcoma.
  
  
  METHODS
  A single center retrospective evaluation of clinical management and oncologic outcome was conducted with 15 pathological fracture patients (M:F = 10:5; age: mean 23.2, range 12-42) and 50 non-fracture patients between April 2002 and December 2010. These stage IIB osteosarcoma patients were matched for age, tumor site (femur, tibia, and humerus), and osteosarcoma subtype (i.e., control patients with osteosarcoma in the same sites as the fracture patients). All osteosarcoma patients with pathological fractures underwent brace or cast immobilization, adjuvant chemotherapy, and limb salvage surgery or amputation. Musculoskeletal Tumor Society (MSTS) functional scores were assessed. The mean follow-up time was 34.7 months (range, 8-47 months).
  
  
  RESULTS
  Following limb salvage surgery, no statistical differences were observed in major complications (fracture = 20.0%, control = 12.0%, P = 0.43) or local recurrence complications (fracture = 26.7%, control = 14.0%, P = 0.25). Overall 3-year survival rates of the fracture and control groups (66.7% and 75.3%, respectively) were not statistically different (P = 0.5190). Three-year disease-free survival rates of the fracture and control groups were 53.3% and 66.5%, respectively (P = 0.25).
  
  
  CONCLUSIONS
  Pathologic fracture was not a prognostic indicator of recurrence or overall survival in localized osteosarcoma patients. Limb salvage can be achieved by and maintaining adequate surgical margins and applying adjuvant chemotherapy.
authors.affiliation: Musculoskeletal Oncology Center, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Dongqing
authors.initials: D
authors.lastname: Zuo
authors.forename: Longpo
authors.initials: L
authors.lastname: Zheng
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
authors.forename: Yingqi
authors.initials: Y
authors.lastname: Hua
authors.forename: Zhengdong
authors.initials: Z
authors.lastname: Cai
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications*; D005598:Fractures, Spontaneous / Q000150:complications*; D006801:Humans; D023821:Limb Salvage / Q000009:adverse effects*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult